Surgical Correction Of Aortic Coarctation Research Articles

The introduction of surgical simulation on three-dimensional-printed models in the cardiac surgery curriculum: an experimental project.

Training in congenital cardiac surgery has become more and more difficult because of the reduced opportunities for trainees in the operating room and the high patient anatomical variability. The aim of this study was to perform a pilot evaluation of surgical simulation on a simple 3D-printed heart model in training of young surgeons and its potential inclusion in the curriculum of residency programs. A group of 11 residents performed a surgical correction of aortic coarctation using a 3D-printed surgical model. After teaching the surgical procedure, a simulation was performed twice, at different times, and was evaluated quantitatively and qualitatively by a senior surgeon. A 3D model-based training program was then developed and incorporated into our cardiac surgery training program. A significant improvement in surgical technique was observed between the first and second surgical simulations: median of 65% [interquartile range (IQR) = 61-70%] vs. 83% (IQR = 82-91%, P < 0.001). The median time required to run the simulation was significantly shorter during the second simulation: 39 min (IQR = 33-40) vs. 45 min (IQR = 37-48; P = 0.02). Regarding the simulation program, a basic and an advanced program were developed, including a total of 40 different simulated procedures divided into 12 sessions. Surgical simulation using 3D-printing technology can be an extremely valuable tool to improve surgical training in congenital heart disease. Our pilot study can represent the first step towards the creation of an integrated training system on 3D-printed models of congenital and acquired heart diseases in other Italian residency programs.

Biatrial flutters: unique circuits requiring a customized ablation approach

Abstract Introduction Atrial futters are macroreentrant tachycardias that typically involve several walls of a certain atrium, being the other atrium passively activated. Biatrial flutters (BAF) are peculiar macro-reentries associated with anterior/septal scars, involving both atria and using the interatrial connections. Purpose To characterize the mechanism of BAF a cohort of patients (pts) submitted to mapping and ablation. Methods Retrospective single-center study of pts with atypical atrial flutter submitted to ablation from 2015 to 2022. High resolution electroanatomical voltage and activation mapping were collected using Carto, Ensite or Rhythmia. Whenever the arrhythmia circuit was not fully displayed in a certain atrium, of the other atrium was mapped to fully characterize the reentrant circuit and establish the critical isthmus. Biatrial circuits were classified into 4 types: type 1, involving the mitral annulus and the tricuspid annulus, escaping the septal wall in both atria; type 2 using most of the mitral annulus and the right atrium (RA) septum; type 3, using both the left atrium (LA) and RA septum; and type 4, using most of the tricuspid annulus and the LA septum. Acute and long-term success was evaluated. Results From a total of 107 pts submitted to atypical flutter ablation, 5 pts presented BAF (3 male, median age: 55-yo), 4 of them previously submitted to cardiac surgery (CABG in 1, mitral valvuloplasty in 1, mitral+tricuspid valvuloplasty in 1 and surgical correction of aortic coarctation and ostium primum atrium septal defect in 1) and 1 had been previously submitted to pulmonary vein isolation (PVI), empirical roof line and cavotricuspid isthmus (CTI) ablation. A proximal-to-distal coronary sinus activation and extensive low-voltage areas at the septum were recognized in all these pts. The BAF mechanism was single loop in all of them, with a type 2 circuit in 2 pts, and types 1, 3 and 4 in one patient each. BAF types 1 and 4 were terminated with CTI ablation. BAF types 2 and 3 were terminated with linear ablations from the mitral annulus to the right superior PV, complemented with focal applications at Bachmann bundle insertion sites in the pts with type 2 BAF. Acute success was achieved in all pts. During a mean time of follow-up of 344±91 days, 1 pt had AFl recurrence. Conclusion BAF is a rare and complex arrhythmia, which is possible to ablate successfully by applying high-density mapping tools, a comprehensive analysis of the substrate/activation maps and a mechanism-tailored ablation strategy.

Surgical Correction of Aortic Coarctation with Left Subclavian Artery and Proximal Descending Thoracic Aorta Aneurysm with moderate Left Ventricular Dysfunction in an adult Female- a case report

In its simplest form, coarctation of the aorta (CoA) refers to congenital narrowing of the thoracic aorta. Usually, a significant pressure gradient between the arms and legs is suggestive of the diagnosis. With the advancement of aortic imaging in our country many CoA patients are diagnosed at an adult age, but the management still carries a challenge. We reported a case of 30-year-old lady with CoA with an aortic aneurysm involving proximal left subclavian artery with proximal DTA and LV dysfunction. J Bangladesh Coll Phys Surg 2023; 41: 93-97

Aortic arch reconstruction in neonates using an autologous pericardial patch

This video tutorial illustrates the surgical correction of aortic coarctation associated with severe hypoplastic aortic arch and a large subaortic ventricular septal defect using a fresh autologous pericardial patch for arch reconstruction under hypothermic cardiopulmonary bypass and selective cerebral perfusion.

Cerebral perfusion protection in newborns after surgical correction of aortic coarctation with aortic arch hypoplasia

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Сравнить неврологические исходы при использовании глубокой гипотермической остановки кровообращения и метода полнопоточной перфузии с помощью двойной канюляции аорты при коррекции коарктации аорты<b></b> с гипоплазией дуги аорты. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В представленном пилотном, одноцентровом, простом, слепом, проспективном, рандомизированном исследовании выполнена оценка непосредственных результатов хирургического лечения врожденной обструктивной патологии дуги аорты в условиях искусственного кровообращения и глубокой гипотермической остановки кровообращения (I группа, 20 человек) или полнопоточной перфузии методом двойной канюляции аорты (II группа, 20 человек) у детей 1-го года жизни. <h3>РЕЗУЛЬТАТЫ</h3> Госпитальная летальность составила 5% (по 1 пациенту) в каждой группе (<i>p</i>&gt;0,05). Неврологические осложнения выявлены у 14 (70%) пациентов из группы глубокой гипотермической остановки кровообращения и у 6 (30%) — из группы двойной канюляции аорты (<i>p</i>=0,025). Единственным фактором риска при многофакторном анализе была сатурация тканей головы по данным церебральной спектроскопии во время основного этапа операции, каждая единица которой снижала риск неврологического события на 6%. <h3>ВЫВОД</h3> Реконструкция дуги аорты с использованием метода полнопоточной перфузии снижает частоту неврологических осложнений по сравнению с глубокой гипотермической остановкой кровообращения. Независимым фактором риска неврологических осложнений была сатурация тканей головы по данным церебральной спектроскопии, каждая единица которой снижала риск неврологического осложнения на 6%.

Cerebral perfusion protection in newborns after surgical correction of aortic coarctation with aortic arch hypoplasia

Aim: To compare the rate of neurologic complications in infants with aortic coarctation and aortic arch hypoplasia undergoing aortic arch repair under deep hypothermic circulatory arrest or full-flow perfusion with double arterial cannulation. Material and Methods: This pilot single-center simple blinded prospective study assessed the early postoperative outcomes in infants with aortic arch obstruction. Patients underwent on-pump repair under deep hypothermic circulatory arrest (I group, 20 patients) or full-flow perfusion with double arterial cannulation (II group, 20 patients). Results: In-hospital mortality was 5% (1 patient) in each group (p&gt;0.05). Neurologic complications occurred in 14 (70%) patients of the 1st group and 6 patients (30%) of the 2nd group (p=0.025). The only significant risk factor was head tissue saturation according to near-infrared spectroscopy. Each percent decreased the risk of neurologic event by 6%. Conclusion: Aortic arch repair under full-flow perfusion reduces the rate of neurologic events in infants compared to deep hypo- thermic circulatory arrest. Head tissue saturation was the risk factor of neurologic complications. Each percent decreased the risk of neurologic event by 6%.

Аномалія Ебштейна та критична коарктація аорти у новонародженого. Нетипове поєднання

This article presents a rare case of combination of Ebstein's anomaly with critical aortic coarctation in a newborn baby, who was admitted to the neonatal intensive care unit of the Regional Children's Hospital needed urgent surgical correction. Purpose — to conduct a literature review of the clinical cases of association of Ebstein's abnormality with critical aortic coarctation in newborns and to present a clinical case of such a rare combination in a newborn boy. Clinical case. A newborn boy was admitted to the neonatal intensive care unit of the Lviv Regional Children's Hospital OHMATDYT, on the second day after his birth with an established diagnosis of Ebstein's anomaly. On admission, the child's general condition was moderate. On ausculation: rhythmic heart tones, tachycardia (heart rate 160 bpm), loud S2 above the pulmonary artery and loud 4/6 systolic murmur across the left sternal border and under the left scapula. The weakened pulsation of the femoral arteries was determined. On Echocardiographic examination: critical aortic coarctation and Ebstein's abnormality have been diagnosed, which is an extremely rare combination. Clinically on the 6th day of the child's life condition significantly worsened: respiratory and cardiovascular failure increased, diuresis decreased, urea and creatinine levels increased. The child was urgently transferred to the intensive care unit to the pediatric cardiac surgery center, where a surgical correction of aortic coarctation was successfully carried out. Surgical correction of Ebstein's anomaly was not performed. Conclusions. The presented clinical case is extremely rare, despite the combination of Ebstein's anomaly and aortic coartation in the neonatal period is not described in the literature, specialists of ultrasound diagnostics should closely monitor the protocol of echocardiographic examination and conduct it in full to diagnose the pathology and perform a timely surgical correction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Ebstein's anomaly, critical aortic coarcia, newborns.

P1280 Vascular and left ventricular mechanics after surgical correction of aortic coarctation of children

Abstract Background The main cause of the suboptimal long-term outcome after surgical correction of aortic coarctation(CoA) is late correction, residual CoA or reCoA. Cardiovascular remodeling after correction CoA in neonatal period without residual CoA is not well established. Purpose Evaluation of global longitudinal strain of the left ventricle (LV) and circumferential mechanics common carotid artery in children 5 years after surgical correction of the CoA in the neonatal period. Methods We examined 58 children aged 5,2 ± 0,39 years after successful repair CoA in neonate period. We excluded children with residual CoA or reCoA. Echo was performed with using vector velocity imaging. We studied LV longitudinal strain (LS) and strain rate (LSR). In the left common carotid artery we estimated: carotid strain (CC S) and strain rate (CC SR), fraction area change (FAC CC), carotid β2-stiffness index (CC β2), and intima-media thickness (IMT). The obtained data were compared with the results of 25 healthy children. Results LS LV and SR LV are worse of children after CoA correction compare with healthy, even LV ejection fraction is similar to healthy children. We found correlation LV mass index (LV MI) with CC S and CC SR. CC β2 of children after Co A repair was higher than of control group. CC β2 correlated with LS LV, SR LV and with LV MI. IMT and FAC didn’t differ of operated and healthy children. Conclusion Parameters of the LS of the LV and CC β2 of children 5 years after CoA repair significantly differ from healthy children and reflect the ongoing process of cardiovascular remodeling. Assessment of the CC S allows timely confirmation of the presence of increased arterial stiffening.

Features of arterial pressure indicators in the postoperative period after surgical correction of aortic coarctation in children

Coarctation of the aorta is a congenital heart disease, which is characterized by a local narrowing of the vessel lumen. Such a congenital anomaly of the aorta requires surgical treatment. Manifestations of the disease can be diagnosed in the first day after birth as well as some patients can be asymptomatic. Clinical signs of aortic coarctation are heart failure, hypertension in the upper extremities, hypotension in the lower extremities, ischemic manifestations in the organs, hemodynamic disorders. Untimely treatment of aortic anomalies leads to complications or death of patient. The results of 24-hour blood pressure monitoring in children after surgical correction of aortic coarctation are presented in the article. Despite the successful surgical treatment of congenital aortic malformation, the long-term results of the operation are far from satisfactory. Almost 12–18 % of the patients having undergone surgery continue to be hypertensive with the vascular dysfunction development and without signs of recoarctation. Patients receive antihypertensive medications, sometimes their combinations, for a long time. Assessment of the daily blood pressure profile features in the postoperative period would help determine pathogenetic mechanisms of the hypertensive syndrome persistence and predict the pathological process course. The aim of the study was to assess the arterial pressure indices in children after successful surgical treatment of coarctation of the aorta. Materials and methods. The main group consisted of 24 children after surgical correction of aortic coarctation. The control group consisted of 20 practically healthy children. Results. A statistically significant decrease in the average diastolic blood pressure during a 24-hour period and daytime diastolic blood pressure and an increase in the daily systolic blood pressure index were determined in the main group children based on the results of 24-hour blood pressure monitoring. Conclusions: The majority of children had low general well-being in the postoperative period. Indicators of systolic and diastolic blood pressure measured by Korotkov method (83.3 %) and 24-hour blood pressure monitoring parameters were typical for hypertension in majority of patients (66.7 %). Abnormalities of the circadian profile (“non-dipper”, “over-dipper”) were detected in 50.0 % of the main group children.

Качество жизни детей после оперативного лечения коарктации аорты

The questionnaire study outcomes of children after surgical correction of aortic coarctation are presented in the article. Factors influencing the patients' quality of life after surgical treatment of congenital heart disease are identified. Objective: to evaluate the quality of life in children after surgical treatment of aortic coarctation. Materials and methods. In total 36 children aged from 6 to 15 years after surgical treatment of aortic coarctation were interviewed. The English version of the Pediatric Quality of Life Inventory™ 3.0 Cardiac Module (PedsQL Cardiac Module) was used to assess the quality of life. Results. In 68.88% of cases children considered their life to be full, 27.77% (10 patients) incomplete, 8.33% (3 patients) found it difficult to answer. All patients noted the physical activity limitation by doctors and parents; 52.77% of respondents emphasized the communication problems and psychological difficulties; in 41.66% of cases, the children reported overprotection by their parents; in 33.33% of cases, there was an arterial hypertension; 27.77% of respondents reported about deterioration of the general sense of well-being, 25.00% of patients had learning difficulties due to congenital heart disease. Conclusions. Despite the satisfactory surgical treatment outcomes, the patients noted a decrease in their quality of life due to various factors. The most significant were as follows: disturbance in well-being, physical activity limitation, constant control by parents, the need for medical treatment and regular visits to doctors.

Echocardiographic Follow up After Surgical Correction of Aortic Coarctation During The First Year of Life

Abstract Coarctation of the aorta (AoCo) accounts for 6–10% of congenital heart diseases in infants. We analysed echocardiographic findings of patients operated on for AoCo in the University Hospital for Children in Riga during the first year of life to evaluate the long-term findings. Fifty-nine children underwent surgical correction of AoCo at the age of 55 ± 61 days. The methods of surgical correction were anastomosis end-to-end (ETE) in 29% (n = 17), subclavian flap aortoplasty (SFA) in 64% (n = 38) and extended anastomosis end-to-end (EETE) in 7% (n = 4). Recoarctation developed in 15 patients (25%) with no difference between surgical techniques (P &gt; 0.05). The recoarcation patients had left ventricle hypertrophy (left ventricle mass index (LVMi) 76 ± 19 g/m2.7) normalising after angioplasty (LVMi 42 ± 7 g/m2.7). Patients with recoarctation had a decreased pulsed wave (PW) Doppler systolic/diastolic ratio in abdominal aorta 2.3 ± 0.4 versus patientswithout recoarctation 5.3 ± 1.2 and the control group 6.3 ± 1.4 (P &lt; 0.05). A high incidence of recoarctation exists in patients operated on for AoCo as small infants. Life-long surveillance is required to monitor and to intervene in a timely way. Supplementation of the echocardiographic protocol with an evaluation of PW Doppler flow pattern in abdominal aorta can provide additional information about the presence of obstruction.

Unusual findings in secondary hypertension: double orifice mitral associated to aortic coarctation, bicuspid aortic valve, and ventricular septal defect

Double orifice mitral valve is a rare congenital anomaly presenting as the division of the mitral orifice into two anatomically distinct orifices, it is most often associated with other congenital heart defects such as left-sided obstructive lesions, ventricular septal defects or aortic coarctation. We report the case of a 15 year’s old boy, admitted for arterial hypertension, auscultation revealed a rude aortic systolic murmur. Femoral pulses were weak. Owing to the suspicion of aortic coarctation, transthoracic echocardiography was performed, the aortic coarctation with dilation of the aorta proximal to the stenosis was confirmed and bicuspid aortic valve was found with good function. The mitral valve was dysmorphic, having two orifices; it was divided into 2 separate valve orifices by a fibrous bridge. No mitral or aortic regurgitation was documented by color Doppler flow imaging. The left ventricular ejection fraction was normal. There was a small peri membranous ventricular septal defect with left to right shunt. Owing to the severity of the aortic coarctation and taking into account the anatomy and characteristics of the patient, he was made a surgical correction of aortic coarctation with good outcome.

Reparación quirúrgica de coartación aórtica en lactantes menores

The study's purpose is to present our experience with surgical correction of aortic coarctation in infants, at short and medium term, particularly morbidity and mortality. This is a retrospective observational and descriptive trial. We included all infant patients undergoing surgical correction of AC. All data were obtained from the clinical database of the hospital. We included 20 patients with AC. The surgical technique was extended coarctectomy in 19 patients and, in one patient, a subclavian artery flap was performed. In all patients, the average time of aortic clamping was 18min. The residual gradient measured by echocardiography was in average of 12.2mmHg. One patient died of sepsis secondary to pneumonia. The main cause of immediate postoperative morbidity was systemic hypertension in seven patients, nosocomial infection in four patients with development of sepsis, one patient had to be reoperated due to high gradient. One patient had cholestatic syndrome. Eighteen patients required a transfusion at some time during their hospital stay. Average in-hospital stay was of 12 days. The aortic coarctation surgery has had favorable results so far and we can conclude that the program has been successful. The surgical technique has shown low mortality and complications and midterm follow-up shows low rate of recoarctation.

Functional Health Status Late after Surgical Correction of Aortic Coarctation

To investigate functional health status among adults previously operated for aortic coarctation (CoA) compared with healthy subjects; to assess the influence of medication and exercise capacity on patients' functional health. Questionnaire-based investigation among 119 patients who underwent surgical repair of CoA during 1965-1985 and 36 age- and gender-matched healthy subjects using the SF-36 health survey. Original scores were transformed into norm-based scores, and summary scale scores were calculated. Exercise capacity was measured by symptom-limited bicycle ergometer testing. Tertiary referral center. Among 156 current survivors, 119 (74 males) participated in the study. Median age (range) at repair was 11 (0.1-40) years and 44 (26-72) years at follow-up. Comparison of all components of SF-36 survey between patients and controls, as well as within patients regarding use of cardiovascular medication and exercise capacity. Norm-based physical functioning scores were significantly lower among patients compared with controls (51.8 ± 7.1 vs. 54.3 ± 4.7, P < 0.05). Patients using antihypertensive medication scored significantly lower in all physical categories (physical component summary= 48.9 ± 10.4 vs. 54.9 ± 4.9, P < 0.05) as well as in vitality (46.4 ± 10.5 vs. 51.4 ± 10.4, P < 0.05). Patients with reduced exercise capacity scored significantly lower in several mental and physical categories compared with patients with normal exercise capacity (physical component summary= 49.7 ± 10.7 vs. 54.0 ± 6.2, P < 0.05; mental component summary= 44.9 ± 14.6 vs. 50.1 ± 10.0, P < 0.05). Functional health status in patients late after CoA repair is only slightly impaired when compared with controls. However, the subgroup with reduced exercise capacity and need for cardiovascular medications have significant impairment on both physical and mental aspects of functional health.

Endovascular Treatment for Pseudoaneurysms after Surgical Correction of Aortic Coarctation

Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coarctation, which were treated by endovascular means.

Repair of Aortic Coarctation in an Adult by Direct Aortoplasty

Various techniques have been proposed for surgical correction of aortic coarctation in adults. We describe direct aortoplasty repair in a 28-year-old woman with native coarctation. Four-year follow-up with magnetic resonance angiography confirmed a good result. This is a safe and effective technique that provides enlargement of the aortic lumen by avoiding extensive anastomotic suture lines or interposition of prosthetic graft material.

Does surgical correction of coarctation of the aorta in adults reduce established hypertension?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether surgical correction of coarctation of the aorta in adults (>16 years) results in reduction in established hypertension. Altogether 484 relevant papers were identified using the below mentioned search, 11 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that surgical repair of coarctation of the aorta in adult patients is superior to conservative management in the reduction of established hypertension, with one meta-analysis and several retrospective reviews reporting low morbidity and low risk of re-stenosis. The reduction in blood pressure postoperatively has been demonstrated consistently, with most patients reported as normotensive without medication and the remainder having reduced requirements for antihypertensive medications. In all the papers included here (except one), there was no early mortality and no procedure-related late mortality during mean follow-up ranging from 2 to 14 years. Thus, surgical correction of aortic coarctation is a relatively safe procedure.

Antegrade endovascular repair of a coarctation-associated aneurysm through an upper hemi-sternotomy

Late aneurysm formation is a well-described complication after surgical correction of aortic coarctation. Endovascular repair of such aneurysms avoids the morbidity of conventional reoperative thoracic surgery. We describe a unique case of antegrade endovascular repair of a distal coarctation-associated aneurysm with vascular access acquired through the aortic arch by an upper hemi-sternotomy.

M.681 Clinical relevance of identification of exercise-induced hypertension in adults who received surgical correction of aortic coarctation in childhood

M.681 Clinical relevance of identification of exercise-induced hypertension in adults who received surgical correction of aortic coarctation in childhood

M.681 Clinical relevance of identification of exercise-induced hypertension in adults who received surgical correction of aortic coarctation in childhood

M.681 Clinical relevance of identification of exercise-induced hypertension in adults who received surgical correction of aortic coarctation in childhood